Tuesday, October 12, 2010
SARAH DAVIS: Midwife, Alternative Health Advocate & Activist
by MARK GABRISH CONLAN
Copyright © 2010 by Mark Gabrish Conlan for Zenger’s Newsmagazine • All rights reserved
Most people who hear the term “midwife” today think it’s a relic of America’s pioneer past, a term for women who helped other women bring their babies into the world before it became routine to go to a hospital and let a doctor — usually a male — do that. That’s what Sarah Davis thought, too, until her senior year in college. She decided to do a research paper on the history of midwifery among African-Americans — and was startled to find that it wasn’t just an historical topic but a living cultural and health-care tradition.
“I hadn’t realized there were still midwives,” Davis recalled. “I thought they had died out after the 1940’s and 1950’s. I didn’t like the process by which Western medicine had driven midwives out” and turned pregnancy and the birth experience from a normal part of women’s lives into a “disease” supposedly needing professional medical treatment. After college, a combination of factors — her interest in family health and alternatives to Western medicine, her Leftist politics and her disinterest in becoming a math teacher, the career she’d had in mind when she went to college — led her to become a midwife herself.
Today Davis operates out of the Birth Roots Women's Health & Maternity Center [http://birthrootsbabies.com], a homey building at 236 F Street in Chula Vista, and assists women giving birth all over San Diego County — sometimes at her center, sometimes in their homes. Asked why a woman would choose to use a midwife instead of going through a hospital birth, she said the reasons have changed over time but the one most common today is “women prioritizing their own safety and thinking they’re safer outside of a hospital, including avoiding unnecessary medical intervention and Cesarean sections; and women and families wanting a safe and comfortable experience where they feel in power and control.”
Other reasons Davis cited include cost — though she admitted it’s sometimes more expensive to use a midwife because a lot of health insurance plans and government programs don’t cover them — and commitment to a vision of health different from the aggressive, disease-driven model of Western medicine. “”People interested in holistic health will avoid hospital births because they see it as a normal experience, not a disease,” Davis explained. “A lot of people are outside the medical system altogether, including religious Fundamentalists and extreme off-the-grid Libertarians.”
Zenger’s interviewed Davis at the Filter coffeehouse in North Park, and for part of the interview another practicing midwife, Kathy Nuttall, sat in and said that for many of her clients, the main reason to use a midwife is to stay in control of their birth experience. “A lot of people who go to hospitals just get strong-armed into doing whatever the doctors say,” Nuttall said. She added that much of the advice women get from doctors in normal obstetrical practice may not even be driven by what the doctor thinks is best, but what will help him or her defend a lawsuit in case of a bad outcome.”
“Obstetricians pay more in malpractice insurance than any other doctors,” Nuttall explained. She said that the average obstetrician grosses about $200,000 per year — but the cost of malpractice insurance alone eats up about $85,000 of that. What’s more, Nuttall said, obstetricians can be sued over a birth until the child has reached 18 — so even a retired obstetrician can have a ticking time bomb somewhere in the form of a child whose parents may haul him into court for some real or alleged injury to their boy or girl. “The more kids they’ve delivered, the more likely they are to be sued.”
The Cesarean Epidemic
According to Davis, the fear of lawsuits against them is what’s driving more and more obstetricians to push their patients into having C-sections. “Cesareans are not medically safer, but they are legally safer,” she explained. “The doctor who performs one can always say in front of a jury, ‘I did everything I could.’” Davis said that the rising rate of C-sections is sometimes blamed on the women themselves for supposedly wanting “elective” ones, but she questions whether any decision a patient makes in a Western medical context can truly be called “elective.”
“The definition of ‘elective’ in a medical context is not what it is normally,” Davis said. “It cam be something a woman is easily manipulated into. ‘Elective’ doesn’t mean it’s a woman’s top choice.” She went on to say that, besides the fear of losing money in lawsuits, doctors have another incentive to push Cesareans: “They make more money off C-sections than from vaginal births, not only because they bill more but also because they can schedule it and do more of them. A C-section takes one hour; labor takes six to eight hours. If you’re an obstetrician, you do C-sections to keep your practice open.”
Nuttall added that C-sections are “major abdominal surgery” that frequently result in infections, abscesses and abdominal scars. What’s more, Davis added, “in the last few years there’s been a push for women who’ve already had a C-section not to be allowed to have another baby vaginally.” This was sound advice in the 1950’s, but more recent advances in medical care have made it possible for women who’ve had Cesareans to give birth to subsequent children normally — and, said Davis, doctors should be telling them that instead of pushing additional C-sections on them. “The evidence is clear that women should have the choice,” she stated.
According to Davis, the advantages of a midwife-assisted birth include not only avoiding the risk of an unnecessary C-section but “a lot of unnecessary and humiliating conditions” women who have their babies in hospitals are put through. “They can give birth in water, they can have music playing, and they can have the people of their choice with them — including their previous kids.”
Indeed, the overall orientation of midwifery is a belief in nature and a rejection of the idea that human science and technology can do a better job of bringing babies into the world than the processes that resulted from millions of years of evolution. That’s why Davis, like most midwives, is a militant advocate of breast-feeding. She’s witheringly scornful of the attempts of formula manufacturers to duplicate the chemicals in breast milk. “Not only do they not come close,” she explained, “but the DHA’s [essential fatty acids] in formula come from algae or mushrooms humans don’t normally eat, and they’re feeding it to tiny babies.”
Asked how much the babies’ fathers are involved in a midwife-assisted birth, Davis said, “Pretty, pretty involved. The mom is our client, and she can choose how much or how little involvement she wants the father or her partner to have. The family can meet us at pre-natal appointments, and by the time of the actual birth we all have a pretty trusting relationship. We step back and see what the family wants from us. We have to do vital signs and listen to the baby’s heartbeat, but most of the time fathers and partners are involved, giving encouragement and in some cases actually catching the baby when it’s born.”
That’s one of the key differences between a midwife-assisted birth and a hospital birth, Davis explained: the level of personal responsibility not only the mother but her entire family takes on when she chooses to go with a midwife. One of Davis’s philosophies as a midwife is that the mother and her partner — whether or not the partner is the biological father — are going to have the responsibility of raising that child for the next 18 years, so the sooner they start taking an active role in their baby’s life, the better.
“We believe the people receiving the baby should be the ones who will be taking care of it,” Davis said. “The mom is delivering a baby, and we’re just there to watch out and make sure things are clinically normal. We’re super-fortunate to live in the urban United States. We can have a really safe low-tech home birth experience, and at the same time we have medications, oxygen, suturing equipment and immediate access to emergency medical services if we need that.”
Though the laws under which midwives practice require them to have doctors on call if the woman or baby develop complications that need professional medical intervention, Davis boasts on behalf of her profession that in only 8 percent of midwife births are the doctors actually needed. “The other 92 percent of women who work with us are having unmedicated, active vaginal births outside the hospital,” she said. “A woman walking into a hospital has a 50 percent chance of having a C-section and a 90 percent chance of epidural anaesthesia.”
Doesn’t It Hurt?
One of the key factors pushing women away from midwives and towards hospitals is the fear of pain. Davis says she doesn’t mince words with her clients; though she’ll do everything in her power to minimize their level of pain, there’s going to be some pain involved because it’s biologically intrinsic to the birth process. “Labor proceeds with a really complex mix of hormones, and the hormones that cause contractions are stimulated by pain,” Davis explained, adding that to her that’s yet another advantage a midwife birth has over one in a hospital.
“When you remove the pain with anaesthesia, you’re going to need to have medical intervention to get labor to continue, and the artificial chemicals don’t work as well as natural processes,” Davis said. “We can’t eliminate pain, but we can eliminate stress. They can be in their own home, walking around, taking a shower.”
“It still hurts a lot!” Nuttall interjected.
“But it’s also important — and this is the 1970’s feminist side of me — to let women know that they are strong. They don’t need to be rescued from pain. Pain is a natural part of becoming a mother. What’s important to us is offering the option of a safe, supported birth without medical intervention, even if it involves pain. Most women who’ve had an unmedicated birth say it’s the hardest thing they’ve ever done, but once they’ve done it they feel they can do anything. That’s what really keeps driving me back to the work: to see how strong women are and to see women empowered after that. Taking away that option is really disempowering for mothers.”
The Legal Issues
When Davis chose midwifery as a career, she explained, she “had to do a lot of soul-searching” over which of the two legal options she should pursue. One was to train as a nurse-midwife, which would have required her to go to nursing school, do the full program to become a registered nurse, get her R.N. license and then, and only then, be trained as a midwife. She chose the other route: to become a “direct-access midwife,” which gave her more freedom not only in terms of how she could practice but also where. She’s helped women deliver babies in their homes, in hotel rooms, and now in a free-standing birth center in Chula Vista — all of which would have been more difficult if she’d taken the full nurse-midwife training and become licensed that way.
On the other hand, nurse-midwives have more access to the medical system, and they’re legal in all 50 U.S. states, Davis explained. “Direct-entry midwives are legal in 26 states, up from 20 when I started practicing, which means in 24 states our status is still in question,” she said. “”In California right now my reality is as long as I more or less do what I’m supposed to do, I won’t go to jail. But if I were practicing in Illinois and I ran into an aggressive district attorney, I could go to jail — and if there were an adverse birth outcome I would definitely go to jail.”
Politics and Alternative Health
The whole issue of licensing, Davis said, helps feed the extreme Libertarian convictions of many midwives and other practitioners and supporters of alternatives to the Western medical mainstream. “A lot of people think there should be no government involvement in health,” Davis said — and, though she considers herself a Leftist, she added that she agrees with many of their views.
“One thing about Western medicine is it allows people not to take responsibility for their health risks,” Davis explained. “As soon as [a pregnant woman] checks into a hospital, if their baby dies or has health complications, they can sue, and they might get a settlement that helps keep their child cared for.” Sometimes, she added, the person or institution that’s on the hook legally isn’t responsible for the bad outcome — and sometimes nobody is. “The reality is that some babies have birth defects that are incompatible with life; some babies who die could have been saved by more technological intervention; and some babies will die because of the technology,” Davis said.
Indeed, Davis sees Western medicine’s obsession with elaborate technological fixes, and the demonization of any negative outcome as “malpractice” for which doctors and hospitals need to be held legally liable, as just part of a society-wide denial of death. “We are a society that is really afraid of death,” she said. “We really believe no baby should die during pregnancy, birth or in the first few months of life, and every resource should be used to avoid death.”
Instead of denying the risks of coming into the world — as well as the inescapable reality that, no matter how long it takes, everybody leaves it pretty much the same way — Davis says people should own up to their own responsibilities and make their choices accordingly. “When we’re choosing to have a baby in or out of a hospital, we’re at risk either way,” she said. “But psychologically, one thing that changes when you have a baby at home is you’re taking responsibility for that choice, just as you’re going to be responsible for raising it.”
But though Davis may sound like a political conservative every time she uses the term “personal responsibility,” her Leftist convictions come through loud and clear when she talks about why mainstream medicine in the U.S. is the way it is. “The current medical establishment is profit-driven,” she said. “It’s not interested in individual health, and it’s certainly not interested in community health. As long as health is a for-profit business, health problems have to exist to further that industry. Also, Western medicine is extremely hierarchical. It’s based on the assumption that individual people don’t understand their own health. That model is disempowering for individuals.”